US5036868A - Anastomosis preparation technique - Google Patents

Anastomosis preparation technique Download PDF

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Publication number
US5036868A
US5036868A US07/578,544 US57854490A US5036868A US 5036868 A US5036868 A US 5036868A US 57854490 A US57854490 A US 57854490A US 5036868 A US5036868 A US 5036868A
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Prior art keywords
vessel
shaped member
pressure medium
vertical part
vertical
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Expired - Fee Related
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US07/578,544
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Anders Berggren
Hakan Rohman
Rafn Ragnarsson
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MEDICAL Cos ALLIANCE Inc
Unilink Inc
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Unilink Inc
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Priority to US07/578,544 priority Critical patent/US5036868A/en
Priority to US07/739,849 priority patent/US5323789A/en
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Publication of US5036868A publication Critical patent/US5036868A/en
Assigned to ANTARES LEVERAGED CAPITAL CORP., AS AGENT reassignment ANTARES LEVERAGED CAPITAL CORP., AS AGENT SECURITY INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: MEDICAL COMPANIES ALLIANCE, INC., A UTAH CORP.
Assigned to MEDICAL COMPANIES ALLIANCE, INC. reassignment MEDICAL COMPANIES ALLIANCE, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: ANTARES LEVERAGED CAPITAL CORPORATION
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis

Definitions

  • This invention relates to anastomotic preparation techniques, and in particular, to a method for minimizing constrictions in blood vessels at the sight of branching during anastomotic ring placement.
  • constricted vessels can be replaced by healthier ones that are coupled in parallel or connected to other vessel locations.
  • vessels have been joined with a common technique of sewing the vessels together with sutures.
  • anastomosis rings have become available for joining blood vessels, for example, in end-to-side anastomosis. This technique is accomplished by puncturing a small cut in a first blood vessel, which is then flared and placed over the pins of an anastomosis ring. The flared joint can then be attached with a complementary anastomosis ring to the end of a second vessel. In this way, it is possible to conduct a branching or by-passing procedure in considerably less time than with conventional suturing techniques. The use of anastomosis rings, in this fashion, is known to diminish the risks to the patient and conserve resources.
  • a procedure for minimizing constrictions in a vessel in a joint area at the sight of anastomotic ring placement.
  • the procedure includes inserting an upper part of a hollow, T-shaped member through an incision in the vessel.
  • the T-shaped member includes a vertical part comprising a pipe or hose and an upper part, which is more elastic than the vertical part, which consists essentially of an expansible elongated balloon in an unexpanded state.
  • the elongated balloon is in open communication with the hollow vertical part.
  • the method also includes pressurizing the hollow portion of the upper part by forcing a pressure medium through the vertical part into the upper part so as to expand the upper part and thereby substantially uniformly deform a portion of the joint area of the vessel.
  • the upper part is depressurized by removing the pressure medium, which allows the upper part to return to its unexpanded state.
  • the upper part of the T-shaped member is then removed from the vessel prior to attachment of an anastomotic ring.
  • the surgical instrument of this invention can provide additional surface area of vessel material for attachment of the anastomotic ring, thereby avoiding a reduction in diameter of the vessel during the surgical procedure.
  • FIG. 1 is a side elevation of a preferred T-shaped instrument of this invention, illustrating an unexpanded upper part;
  • FIG. 2 is a end view of the preferred T-shaped instrument of FIG. 1;
  • FIG. 3 illustrates another side view of the preferred T-shaped instrument of FIG. 1, illustrating how the upper part can be subjected to a pressure medium resulting in an expanded state.
  • a T-shaped instrument having an elastically expansible upper part that includes a piece of a thin-walled hose, and a vertical part which can include another hose connected to a pressure source.
  • the pressure source can conveniently be supplied by a common injection syringe.
  • the two branches of the upper part of the T-shaped instrument can be inserted longitudinally within the vessel through a small cut or incision at the site of branching in the vessel.
  • the upper part of the instrument is preferably expanded and the vessel can be expanded to about twice its original diameter.
  • the pressure medium in the upper part of the instrument can then be evacuated to permit facilitated removal of the instrument from the vessel prior to applying anastomotic rings.
  • the vessel can then, for example, be joined to the end of a second vessel to provide end-to-side anastomosis.
  • the vessel stretched with the T-shaped instrument of this invention is not entirely elastic, it will retain its expansion for a sufficient time for minimizing constrictions during the application of anastomotic rings. Moreover, tests have demonstrated that the uniform stress created by the upper part of the T-shaped instrument minimizes the incidence of rupturing or tearing of the incision in the vessel during expansion. This represents a benefit over other attempts to expand the vessel by means of pincettes, or the like.
  • the instrument shown in FIG. 1 includes a thick-walled connection hose 1 of plastic, which has been welded to a side opening 2 in a thin-walled elastic plastic hose 3.
  • the hose 3 includes end portions 4 and 5 which can be welded together.
  • the hose 1 is very thin and preferably includes a diameter that fits on a tip of an injection syringe.
  • FIG. 3 the instrument has been subjected to a pressure medium from the syringe or other source. As illustrated, the thin-walled upper part 3 of the instrument has been expanded.
  • connection hose 1 is preferably about 1 mm
  • the upper part also referred to as the "balloon part” has a preferred diameter of about 2 mm and a preferred length of about 8 mm in the unaffected or unpressurized state.

Abstract

This invention provides a surgical method for minimizing constrictions in a vessel in a joint area at the site of an anastomotic ring placement. The method includes inserting an upper part of a hollow, T-shaped member through an incision in a vessel. The T-shaped member includes a vertical part comprising a pipe or hose and an upper part which is more elastic than the vertical part and consists essentially of an expansible elongated balloon in an unexpanded state. The elongated balloon is an open communication with the hollow vertical part and can be expanded by pressurizing with a pressure medium through the vertical part into the upper part so as to expand the upper part and thereby substantially uniformly deform a portion of the joined area of the vessel. The method also includes depressurizing the upper part by removing the pressure medium and allowing the upper part to return to its unexpanded state and then removing the upper part from the vessel prior to attachment of an anastomotic ring to the vessel.

Description

Cross Reference to Related Applications
The present application is a continuation of U.S. Ser. No. 471,706 abandoned, filed on Jan. 29, 1990, which in turn, is a continuation of U.S. Ser. No. 235,882 abandoned, filed on Aug. 18, 1988, as a U.S. National patent application, which is a result of the completion of the P.C.T. phase of P.C.T. Ser. No. PCT/SE87/00596, filed on Dec. 11, 1987. The P.C.T. application claims priority based on Swedish patent application, Serial No. 8605455-8, filed on Dec. 18, 1986. All of these applications were filed in the name of the present inventors and are assigned to the Assignee of the instant application. Furthermore, all of these applications are incorporated herein by reference in their entirety.
Field of the Invention
This invention relates to anastomotic preparation techniques, and in particular, to a method for minimizing constrictions in blood vessels at the sight of branching during anastomotic ring placement.
BACKGROUND OF THE INVENTION
In vessel surgery, it has become increasingly useful to use by-passes, for example, constricted vessels can be replaced by healthier ones that are coupled in parallel or connected to other vessel locations. Until now, vessels have been joined with a common technique of sewing the vessels together with sutures.
More recently, anastomosis rings have become available for joining blood vessels, for example, in end-to-side anastomosis. This technique is accomplished by puncturing a small cut in a first blood vessel, which is then flared and placed over the pins of an anastomosis ring. The flared joint can then be attached with a complementary anastomosis ring to the end of a second vessel. In this way, it is possible to conduct a branching or by-passing procedure in considerably less time than with conventional suturing techniques. The use of anastomosis rings, in this fashion, is known to diminish the risks to the patient and conserve resources.
Regretfully, the use of anastomosis rings for end-to-side joining of blood vessels is not entirely without draw backs. It has been found that the application of the anastomosis rings to a vessel steals material from the vessel and results in a constriction in its diameter. This is undesirable, since one of the objectives of a by-pass is to improve flow, and not to replace one impedance to flow with another. Accordingly, there is a need for a technique and instrument for eliminating constrictions caused by anastomotic ring placement.
SUMMARY OF THE INVENTION
In accordance with the present invention, a procedure has been developed for minimizing constrictions in a vessel in a joint area at the sight of anastomotic ring placement. The procedure includes inserting an upper part of a hollow, T-shaped member through an incision in the vessel. The T-shaped member includes a vertical part comprising a pipe or hose and an upper part, which is more elastic than the vertical part, which consists essentially of an expansible elongated balloon in an unexpanded state. The elongated balloon is in open communication with the hollow vertical part. The method also includes pressurizing the hollow portion of the upper part by forcing a pressure medium through the vertical part into the upper part so as to expand the upper part and thereby substantially uniformly deform a portion of the joint area of the vessel. After the vessel has been deformed, the upper part is depressurized by removing the pressure medium, which allows the upper part to return to its unexpanded state. The upper part of the T-shaped member is then removed from the vessel prior to attachment of an anastomotic ring.
Accordingly, constrictions are minimized in the vessel and a more successful by-pass or branching operation can be performed. It is believed that the surgical instrument of this invention can provide additional surface area of vessel material for attachment of the anastomotic ring, thereby avoiding a reduction in diameter of the vessel during the surgical procedure.
BRIEF DESCRIPTION OF THE DRAWINGS
The accompanying drawings illustrate an preferred embodiment of the invention, as well as other information pertinent to the disclosure, and in which:
FIG. 1: is a side elevation of a preferred T-shaped instrument of this invention, illustrating an unexpanded upper part;
FIG. 2: is a end view of the preferred T-shaped instrument of FIG. 1; and
FIG. 3: illustrates another side view of the preferred T-shaped instrument of FIG. 1, illustrating how the upper part can be subjected to a pressure medium resulting in an expanded state.
DETAILED DESCRIPTION OF THE INVENTION
In accordance with this invention, a T-shaped instrument is provided having an elastically expansible upper part that includes a piece of a thin-walled hose, and a vertical part which can include another hose connected to a pressure source. The pressure source can conveniently be supplied by a common injection syringe. By pressurizing the elastic upper part of the T-shaped instrument, the upper part can be expanded to stretch the vessel wall, and by evacuating the upper part, it can be made very thin and easier to handle.
The two branches of the upper part of the T-shaped instrument can be inserted longitudinally within the vessel through a small cut or incision at the site of branching in the vessel. Once inserted, the upper part of the instrument is preferably expanded and the vessel can be expanded to about twice its original diameter. The pressure medium in the upper part of the instrument can then be evacuated to permit facilitated removal of the instrument from the vessel prior to applying anastomotic rings. The vessel can then, for example, be joined to the end of a second vessel to provide end-to-side anastomosis.
Since the vessel stretched with the T-shaped instrument of this invention is not entirely elastic, it will retain its expansion for a sufficient time for minimizing constrictions during the application of anastomotic rings. Moreover, tests have demonstrated that the uniform stress created by the upper part of the T-shaped instrument minimizes the incidence of rupturing or tearing of the incision in the vessel during expansion. This represents a benefit over other attempts to expand the vessel by means of pincettes, or the like.
With reference to FIG. 1, there is shown a preferred embodiment in accordance with this invention. The instrument shown in FIG. 1 includes a thick-walled connection hose 1 of plastic, which has been welded to a side opening 2 in a thin-walled elastic plastic hose 3. The hose 3 includes end portions 4 and 5 which can be welded together. The hose 1 is very thin and preferably includes a diameter that fits on a tip of an injection syringe.
In FIG. 3, the instrument has been subjected to a pressure medium from the syringe or other source. As illustrated, the thin-walled upper part 3 of the instrument has been expanded.
Although the figures show the instrument in large detail, the diameter of the connection hose 1 is preferably about 1 mm, and the upper part also referred to as the "balloon part" has a preferred diameter of about 2 mm and a preferred length of about 8 mm in the unaffected or unpressurized state.
From the foregoing, it has been demonstrated that this invention provides a very hygienic and economic surgical instrument for expanding blood vessels at the site of anastomotic ring placement. Although various embodiments have been illustrated, this was for the purpose of describing, but not limiting, the invention. Various modifications, which will become apparent to one skilled in the art, are within the scope of the invention described in the attached claims.

Claims (5)

What is claimed is:
1. A method for minimizing constrictions in a vessel in a joint area comprising:
inserting an upper part of a hollow, T-shaped member through an incision in said vessel, the T-shaped member including a vertical part comprising a pipe or hose, the upper part being more elastic than the vertical part and consisting essentially of an expansible elongated balloon in an unexpanded state, said elongated balloon being in open communication with the hollow vertical part;
pressurizing the hollow portion of the upper part by forcing a pressure medium through said vertical part and into the upper part so as to expand the upper part and thereby substantially uniformly a portion of the vessel in said joint area, wherein said pressurizing step expands said vessel to provide additional surface area of vessel material;
depressurizing the upper part by removing the pressure medium from the upper part, allowing the upper part to return to its unexpanded state; and
removing the upper part of said T-shaped member from said vessel.
2. The method of claim 1, wherein the step of depressurization comprises evacuating the upper part causing the upper part to collapse to a size smaller than its original unexpanded state.
3. The method of claim 1, wherein said pressurizing step comprises expanding the upper part of the T-shaped member to approximately twice its unexpanded size.
4. The method of claim 1, wherein the pressure medium is provided to the T-shaped member by means of a syringe attached to an end of the vertical part.
5. The method of claim 3, wherein the upper part of the T-shaped member is approximately 2 millimeters in diameter and approximately 8 millimeters in length.
US07/578,544 1986-12-18 1990-09-06 Anastomosis preparation technique Expired - Fee Related US5036868A (en)

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US07/578,544 US5036868A (en) 1990-01-29 1990-09-06 Anastomosis preparation technique
US07/739,849 US5323789A (en) 1986-12-18 1991-08-02 Anastomosis preparation technique with easily insertable member

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US47170690A 1990-01-29 1990-01-29
US07/578,544 US5036868A (en) 1990-01-29 1990-09-06 Anastomosis preparation technique

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US5323789A (en) * 1986-12-18 1994-06-28 Minnesota Mining And Manufacturing Company Anastomosis preparation technique with easily insertable member
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US5400773A (en) * 1993-01-19 1995-03-28 Loma Linda University Medical Center Inflatable endoscopic retractor
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US5925054A (en) * 1996-02-20 1999-07-20 Cardiothoracic Systems, Inc. Perfusion device for maintaining blood flow in a vessel while isolating an anastomosis
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US6315717B1 (en) 1996-02-20 2001-11-13 Cardiothoracic Systems, Inc. Surgical instruments for stabilizing the beating heart during coronary artery bypass graft surgery
US6322536B1 (en) 1998-03-06 2001-11-27 Cornell Research Foundation, Inc. Minimally invasive gene therapy delivery and method
US6394951B1 (en) 1996-02-20 2002-05-28 Cardiothoracic Systems, Inc. Surgical instruments and procedures for stabilizing the beating heart during coronary artery bypass graft surgery
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US6508802B1 (en) 2000-05-23 2003-01-21 Cornell Research Foundation, Inc. Remote sensing gene therapy delivery device and method of administering a therapeutic solution to a heart
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US7179224B2 (en) 2003-12-30 2007-02-20 Cardiothoracic Systems, Inc. Organ manipulator and positioner and methods of using the same
US7219671B2 (en) 1995-04-10 2007-05-22 Cardiothoracic Systems, Inc. Method for coronary artery bypass
US7479104B2 (en) 2003-07-08 2009-01-20 Maquet Cardiovascular, Llc Organ manipulator apparatus
US20100114301A1 (en) * 2008-10-31 2010-05-06 Vioptix, Inc. Vessel Right Sizer
US20100114292A1 (en) * 2008-10-31 2010-05-06 Vioptix, Inc. Vessel Extender
US7931590B2 (en) 2002-10-29 2011-04-26 Maquet Cardiovascular Llc Tissue stabilizer and methods of using the same
US7947062B2 (en) 2001-12-26 2011-05-24 Maquet Cardiovascular Llc Temporary anastomotic seal and method
US8083664B2 (en) 2005-05-25 2011-12-27 Maquet Cardiovascular Llc Surgical stabilizers and methods for use in reduced-access surgical sites
US8753266B2 (en) 1997-09-17 2014-06-17 Maquet Cardiovascular Llc Device to permit offpump beating heart coronary bypass surgery
US9022998B2 (en) 2010-02-26 2015-05-05 Maquet Cardiovascular Llc Blower instrument, apparatus and methods of using
US9655605B2 (en) 2010-06-14 2017-05-23 Maquet Cardiovascular Llc Surgical instruments, systems and methods of use
WO2022022235A1 (en) * 2020-07-28 2022-02-03 上海火点医疗器械有限公司 Lumen anastomosis support dilator

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US7056287B2 (en) 1996-02-20 2006-06-06 Cardiothoracic Systems, Inc. Surgical instruments and procedures for stabilizing the beating heart during coronary artery bypass graft surgery
US6214022B1 (en) 1996-02-20 2001-04-10 Cardiothoracic Systems, Inc. Perfusion device for maintaining blood flow in a vessel while isolating an anastomosis
US6893391B2 (en) 1996-02-20 2005-05-17 Cardiothoracic Systems, Inc. Surgical devices for imposing a negative pressure to stabilize cardiac tissue during surgery
US5769870A (en) * 1996-02-20 1998-06-23 Cardiothoracic Systems, Inc. Perfusion device for maintaining blood flow in a vessel while isolating an anastomosis
US8382654B2 (en) 1996-02-20 2013-02-26 Maquet Cardiovascular Llc Surgical devices for imposing a negative pressure to stabilize the cardiac tissue during surgery
US6290644B1 (en) 1996-02-20 2001-09-18 Cardiothoracic Systems, Inc. Surgical instruments and procedures for stabilizing a localized portion of a beating heart
US6315717B1 (en) 1996-02-20 2001-11-13 Cardiothoracic Systems, Inc. Surgical instruments for stabilizing the beating heart during coronary artery bypass graft surgery
US6852075B1 (en) 1996-02-20 2005-02-08 Cardiothoracic Systems, Inc. Surgical devices for imposing a negative pressure to stabilize cardiac tissue during surgery
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US6394951B1 (en) 1996-02-20 2002-05-28 Cardiothoracic Systems, Inc. Surgical instruments and procedures for stabilizing the beating heart during coronary artery bypass graft surgery
US6701930B2 (en) 1996-02-20 2004-03-09 Cardiothoracic Systems, Inc. Surgical instruments and procedures for stabilizing the beating heart during coronary artery bypass graft surgery
US8277476B2 (en) 1996-02-20 2012-10-02 Maguet Cardiovascular LLC Surgical instruments and procedures for stabilizing the beating heart during coronary artery bypass graft
US7485090B2 (en) 1996-02-20 2009-02-03 Maquet Cardiovascular Llc Surgical devices for imposing a negative pressure to stabilize cardiac tissue during surgery
US6673013B2 (en) 1996-02-20 2004-01-06 Cardiothoracic Systems, Inc. Surgical instruments and procedures for stabilizing the beating heart during coronary artery bypass graft surgery
US7585277B2 (en) 1996-02-20 2009-09-08 Maquet Cardiovascular Llc Surgical instruments and procedures for stabilizing the beating heart during coronary artery bypass graft surgery
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